Conference Highlights: CROI 2018

Though research indicates that cardiovascular disease risk in higher among patients with HIV than those without the disease, data on the risk of peripheral artery disease in those with HIV are lacking. To address this research gap, study investigators compared prevalence and risk factors for PAD in patients with HIV and age- and gender-matched controls. Patients with HIV had a 125 prevalence rate for PAD, compared with a 6% for controls. Age, female gender, smoking status, hypertension, intermittent claudication, and kidney function were all independently associated with PAD risk, regardless of HIV status. Among those with HIV, previous AIDS, CD4 nadir, CD4 count, CD4:CD8 ratio, HCV coinfection, combination antiretroviral therapy, and duration of infection were not associated with PAD.

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HIV Acquisition & Pregnancy

HIV prevention interventions for women can be critically informed by per-sex act analyses that contribute to the understanding of the absolute and relative risks of HIV transmission and provide insight into whether increased risk during pregnancy and postpartum is attributable to biologic or sexual behavior changes. For a study, researchers followed HIV serodiscordant couples with HIV uninfected female partners for up to 48 months. HIV transmission probability was 1.05 per 1,000 sex acts when women were not pregnant, compared with 2.19 during early pregnancy, 2.97 during late pregnancy, and 4.18 during the postpartum period. HIV transmission probability per sex act remained significantly higher during late pregnancy and postpartum, when compare with non-pregnant periods, even after adjusting for condom use, age, HIV pre-exposure prophylaxis use, and HIV viral load.

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In-Hospital ART Predicts Treatment Engagement

Few studies have assessed factors related to initiating in-hospital ART and its association with engagement in care and viral suppression. An examination of differences between HIV-positive patients prescribed or not prescribed ART while hospitalized looked at the likelihood of subsequent engagement in HIV care and viral suppression. Opioid use and substance use treatment were associated with greater likelihood of receiving in-hospital ART. At 12-month follow-up, those who started ART in the hospital had a median of 29 days before their first HIV primary care visit, compared with 54 days for those who did not. However, after controlling for these factors and study group, in-hospital ART initiation was not associated with viral suppression at 6 or 12 months.

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Incident HIV, HCV & Other STIs by PrEP Type

Speculation exists over whether or not HIV pre-exposure prophylaxis (PrEP) may lead to increased rates of sexually transmitted infections (STIs). HIV, hepatitis C virus (HCV), and bacterial STI incidence among men who have sex with men (MSM) and transgender patients—who could choose between daily and event-driven PrEP—were examined for a study with an average follow-up of 15 months. HIV incidence rates per 100 person years were 0.42 overall, 0.57 for those on daily PrEP, and 0.0 for those on event-driven PrEP. HCV incidence rates per 100 person years were 1.29 overall, 1.16 for those on daily PrEP, and 1.68 for those on event-driven PrEP. Bacterial STI (chlamydia, gonorrhea, syphilis) incidence rates per 100 person years were 97.8 overall, 111.4 for those on daily PrEP, and 57.9 for those on event-driven PrEP.

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Youth-Focused Care for Young HIV-Positive Adults

Data suggest that young adults with HIV are less likely to be retained in care or achieve viral suppression when seen in adult clinics. To assess outcomes of this patient population when newly entering or transitioning from pediatric care, those enrolled into a youth-focused care model embedded in an adult HIV clinic—The Accessing Care Early program (ACE) were compared with those who received standard of care (SOC) in the general adult clinic. ACE included providers trained in internal medicine or pediatrics who were supported by a nurse, social worker, and peer navigator. Among ACE patients, 16% were lost to follow-up, compared with 37% of SOC patients. At 24 months, 49% in the ACE group and 26% in the SOC group met the study’s retention measure. However, for those who met the retention measure, 60% of ACE patients were virally suppressed, compared with 89% of SOC patients, underscoring challenges with adherence.

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Outcomes in HIV Patients With CKD

While risk factors for chronic kidney disease (CKD) among patients with HIV are well established, less is known regarding prognosis following CKD diagnosis in this population or the role of modifiable risk factors for serious clinical outcomes (SCOs). For a study, patients with HIV who developed CKD after 2004 were followed from CKD diagnosis until an incident SCO, 6 months after their last visit, or February 1, 2016. SCO rates were compared between patients with and without CKD. During a median follow-up of 2.7 years, patients with CKD had an incident rate (IR) of 68.9 per 1,000 person years of follow up (PYFU), with an estimated 7.9% having a SCO at 1 year. Among those without CKD, the SCO IR at 1 year was 23.0 per 1,000 PYFU. The most common SCO among patients with CKD was mortality (12.7%), followed by non-AIDS-defining malignancy (5.8%), cardiovascular disease (5.6%), other AIDS (5.0%), end stage renal disease (2.9%), end stage liver disease (1.0%), and AIDS-defining malignancy (0.8%). In adjusted models, poor HIV control, low BMI, diabetes, smoking, and higher estimated glomerular filtration rate (eGFR) were strongly associated with mortality; poor HIV control, low BMI, and smoking with other AIDS; smoking and diabetes with non-AIDS-defining malignancy; and dyslipidemia, smoking, diabetes, and higher eGFR with cardiovascular disease.